Hemodynamics in the ICU

1. HEMODYNAMICS In the CRITICAL CARE UNIT Sherry L. Knowles, RN, CCRN, CRNI

8. SWAN GANZ CATHETER

9. SWAN GANZ COMPONENTS

10. SWAN GANZ PLACEMENT

11. SWAN GANZ PLACEMENT

19. PA CATHETER WAVEFORMS A wave - due to atrial contraction. Absent in atrial fibrillation. Enlarged in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension. C wave - due to bulging of tricuspid valve into the right atrium or possibly transmitted pulsations from the carotid artery. X descent - due to atrial relaxation. V wave - due to the rise in atrial pressure before the tricuspid valve opens. Enlarged in tricuspid regurgitation. Y descent - due to atrial emptying as blood enters the ventricle. Canon waves - large waves not corresponding to a, v or c waves. Due to complete heart block or junctional arrhythmias.

20. PA INSERTION SEQUENCE

23. PHLEBOSTATIC AXIS

26. RESPIRATORY VARIATION Spontaneous Breathing

27. RESPIRATORY VARIATION

28. END EXPIRATION

29. RAP WAVEFORM RAP WAVEFORM

30. (CVP) RA WAVEFORM & ECG

31. (CVP) RA WAVEFORM (CVP) RA WAVEFORM

32. WEDGING THE CATHETER

33. PAWP TRACING PAWP WAVEFORM

34. PAWP WAVEFORM PAWP WAVEFORM

35. PA vs PAWP WAVEFORM PA vs PAWP WAVEFORM

36. PAWP WAVEFORM & ECG PAWP WAVEFORM

37. PAWP WAVEFORM PAWP WAVEFORM

38. V WAVES PAWP WAVEFORM

39. PAWP WITH V WAVES

40. SVO 2 MONITORING

42. POTENTIAL COMPLICATIONS POTENTIAL COMPLICATIONS Same as arterial pressure monitoring plus the following: Cardiac arrest Air emboli PA hemorrhage or infarction Pulmonary artery extravasation Altered skin integrity Loss of balloon integrity Frank Hemorrhage Pneumothorax/Hemothorax Pulmonary artery rupture Equipment malfunction Electromicroshock Inaccurate pressures Lung ischemia Infection Balloon rupture Catheter displacement Dysrhythmias Thromboembolism Cardiac tamponade Air emboli

46. TROUBLESHOOTING

48. DAMPENED PA WAVEFORM PAWP WAVEFORM

49. ALTERATIONS IN SVO 2

50. ALTERATIONS IN SVO 2

54. TREATMENTS

55. SAMPLE MEASUREMENTS

56. MEASUREMENTS

57. SAMPLE MEASUREMENTS

58. SAMPLE MEASUREMENTS

59. SAMPLE MEASUREMENTS

60. SAMPLE MEASUREMENTS

61. SAMPLE MEASUREMENTS

62. SAMPLE MEASUREMENTS

63. SAMPLE MEASUREMENTS

64. SAMPLE MEASUREMENTS

65. SAMPLE MEASUREMENTS

66. SAMPLE MEASUREMENTS

67. SAMPLE MEASUREMENTS

68. SAMPLE MEASUREMENTS

69. SAMPLE MEASUREMENTS

70. SAMPLE MEASUREMENTS

72. THE END